Surgical resection for pulmonary recurrence of esophageal cancer after curative esophagectomy

Abstract Background Esophageal cancer is the 8th most common cancer in the world. It is an lethal disease, responsible for almost 400.000 deaths by year. Surgical resection is considered the gold standard in esophageal cancer treatment, with a global 15–40% cure rate. In this study, the results of esophageal cancer surgical treatment at Brazilian National Cancer Institute, Abdominal-pelvic Surgical Section, is analyzed. Methods The medical records of 215 patients with esophageal cancer, treated with surgical resection (esophagectomy), between January 1999 and December 2015, were retrospectively studied. The endpoints analyzed in the study were: hospitalization time, operative complications and mortality, and overall survival. Results Esophageal cancer was predominant in male patients; median age was 58 years (27–78). Primary tumor location varied between 7,5 - 41 cm (median 32cm) and tumor extension 1 - 16cm (median 5cm). Median surgical time was 330 minutes (120–720); transhiatal esophagectomy with gastric tube reconstruction was the most used surgical approach. Tumors histopathological types were equaly distributed. ICU (Intensive Care Unit) stay median time was 5 days (1–87) and median hospitalization time was 15 days (5–166). Most common surgical complications were anastomotic leakage (25,5%) and pneumonia (20%), with a surgical morbidity rate of 61,8%. Surgical mortality rate was 12%, with 61% of these cases occuring in the 30 days after surgery. Median 2-year overall survival was 44,3 months. Conclusion Besides the high surgical morbidity, esophagectomy for esophageal cancer remains the standard treatment for patients with ressectable tumors and without clinical contraindications for surgery. Reduction of surgical mortality depends on rigorous patients selection, surgical team expertise and adequate perioperative and postoperative care. Disclosure All authors have declared no conflicts of interest.

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Palliative esophagectomy in unexpected metastatic disease: sense or nonsense?

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492318797228 ◽

2018 ◽

Vol 26 (7) ◽

pp. 552-557 ◽

Cited By ~ 2

Author(s):

Lieven P Depypere ◽

Johnny Moons ◽

Toni E Lerut ◽

Willy Coosemans ◽

Hans Van Veer ◽

...

Keyword(s):

Esophageal Cancer ◽

Lymph Nodes ◽

Metastatic Disease ◽

Palliative Resection ◽

Oligometastatic Disease ◽

Group 3 ◽

Group 2 ◽

Curative Esophagectomy ◽

Group 1 ◽

Single Organ

Background Despite integrated positron emission tomography and computed tomography screening before and after neoadjuvant treatment in patients with locally advanced esophageal cancer, unexpected metastatic disease is still found in some patients during surgery. Should then esophagectomy be aborted or is there a place for palliative resection? Methods Between 2002 and 2015, 681 patients with potentially resectable esophageal cancer were sheduled for neoadjuvant therapy and subsequent esophagectomy. In 552 patients, a potentially curative esophagectomy was performed. In 12 patients, unexpected disease was discovered during surgery but esophagectomy was performed with synchronous resection of metastases; 10 of them had oligometastatic disease (≤4 single-organ metastases). Esophagectomy was not performed in 117 patients (because of disease progression in 50); 14 were also single-organ oligometastatic. Data of 10 single-organ oligometastatic patients who underwent esophageal resection (group 1) were compared those of 10 non-resected but treated counterparts (group 2) and with 228 patients who underwent potentially curative esophagectomy with persistent pathological lymph nodes (group 3). Results Five oligometastatic esophagectomy patients had lung metastases: 1 peritoneal, 2 adrenal, 1 pleural, and 1 pancreatic. Two oligometastatic non-resected patients had lung, 5 liver, and 3 brain metastases. Median overall survival was 21.4, 12.1, and 20.2 months in the respective groups (group 1 vs. group 2 p = 0.042; group 2 vs. group 3 p = 0.002; group 1 vs. group 3 p = 0.88). Conclusions Survival is longer in patients undergoing palliative esophagectomy with unexpected single-organ oligometastatic disease and comparable to survival in patients with persistent pathological lymph nodes. Palliative resection in these patients seems to be justified.

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Genetic Alterations in Patients With Esophageal Cancer With Short- and Long-Term Survival Rates After Curative Esophagectomy

Annals of Surgery ◽

10.1097/00000658-199708000-00007 ◽

1997 ◽

Vol 226 (2) ◽

pp. 162-168 ◽

Cited By ~ 38

Author(s):

Yutaka Shimada ◽

Masayuki Imamura ◽

Ichio Shibagaki ◽

Hisashi Tanaka ◽

Tokiharu Miyahara ◽

...

Keyword(s):

Esophageal Cancer ◽

Survival Rates ◽

Genetic Alterations ◽

Term Survival ◽

Long Term Survival ◽

Short And Long Term ◽

Curative Esophagectomy

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Role of adjuvant therapy in esophageal cancer patients after neoadjuvant therapy and curative esophagectomy: A systematic review and meta-analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e16083 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e16083-e16083

Author(s):

Yung Lee ◽

Yasith Samarasinghe ◽

Michael H Lee ◽

Luxury Thiru ◽

Yaron Shargall ◽

...

Keyword(s):

Esophageal Cancer ◽

Adjuvant Therapy ◽

Neoadjuvant Therapy ◽

Survival Benefit ◽

Locoregional Recurrence ◽

Curative Resection ◽

Meta Analysis ◽

Distant Recurrence ◽

Curative Esophagectomy

e16083 Background: While neoadjuvant therapy followed by esophagectomy is the standard of care for locally advanced esophageal cancer, the role of adjuvant therapy is uncertain. As such, this review aims to analyze esophageal cancer patients who previously underwent neoadjuvant therapy followed by a curative resection (negative margins) to determine whether additional adjuvant therapy is associated with improved survival outcomes. Methods: MEDLINE, EMBASE, and CENTRAL databases were searched up to August 2020 for studies comparing patients with esophageal cancer who underwent neoadjuvant therapy and curative resection with and without adjuvant therapy. Primary outcome was overall survival (OS), and secondary outcomes were disease-free survival (DFS), locoregional recurrence, and distant recurrence at 1 and 5-years. Random effects meta-analysis was conducted where appropriate. Grading of recommendations, assessment, development, and evaluation (GRADE) was used to assess the certainty of evidence. Results: Ten studies involving 6,462 patients were included. 6,162 (95.36%) patients from 7 studies received adjuvant chemotherapy, whereas 296 (4.58%) patients from 3 studies underwent either adjuvant radiotherapy or chemoradiotherapy. When compared to patients who received neoadjuvant therapy and esophagectomy alone, adjuvant therapy groups experienced a significant overall survival benefit by 48% at 1-year (RR 0.52, 95%CI 0.41-0.65, P < 0.001, moderate certainty). This reduction in mortality was consistent at long-term 5-year follow-up (RR 0.91, 95%CI 0.87-0.96, P < 0.001, moderate certainty). Subgroup analysis on pathologic node positive patients demonstrated a consistent survival benefit at 1-year (RR 0.57, 95% CI 0.42-0.77, P < 0.001, moderate certainty) and 5-year (RR 0.89 95%CI 0.84-0.95, P < 0.001, moderate certainty). While adjuvant therapy presented no benefit for the T0-2 stage subgroup, patients with T3-4 disease experienced a significant reduction in mortality with the addition of adjuvant therapy at both 1-year (RR 0.51, 95% CI 0.41-0.63, P < 0.001, moderate certainty), and 5-years (RR 0.91, 95% CI 0.85-0.97, P = 0.005, moderate certainty). Due to incomplete reporting, the added benefit of adjuvant therapy was uncertain regarding DFS, locoregional recurrence, and distant recurrence. Conclusions: Adjuvant therapy after neoadjuvant treatment and curative esophagectomy provides improved OS at 1 and 5 years, but the benefit for DFS and locoregional/distant recurrence was uncertain due to limited reporting of these outcomes.

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Principles and Approaches in Surgical Resection of Esophageal Cancer

Esophageal Cancer ◽

10.1007/978-3-319-20068-2_9 ◽

2015 ◽

pp. 149-156

Author(s):

Nabil Pierre Rizk

Keyword(s):

Esophageal Cancer ◽

Surgical Resection

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Comparison of endoscopic therapies and surgical resection in patients with early esophageal cancer: a population-based study

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2013.08.002 ◽

2014 ◽

Vol 79 (2) ◽

pp. 224-232.e1 ◽

Cited By ~ 61

Author(s):

Sachin Wani ◽

Jennifer Drahos ◽

Michael B. Cook ◽

Amit Rastogi ◽

Ajay Bansal ◽

...

Keyword(s):

Esophageal Cancer ◽

Surgical Resection ◽

Population Based ◽

Early Esophageal Cancer ◽

Population Based Study

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Endoscopic submucosal dissection of high grade intraepithelial neoplasia of the head and neck in a patient after surgical resection of esophageal cancer

Endoscopy ◽

10.1055/s-0034-1365429 ◽

2015 ◽

Vol 47 (S 01) ◽

pp. E49-E50

Author(s):

Yu-qi He ◽

Ai-qin Li ◽

Xin Wang ◽

Kuang-I Fu ◽

Jian-qiu Sheng

Keyword(s):

Esophageal Cancer ◽

Endoscopic Submucosal Dissection ◽

Head And Neck ◽

Surgical Resection ◽

Intraepithelial Neoplasia ◽

High Grade ◽

Submucosal Dissection

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How does presurgical chemotherapy influence the efficiency of treatment for esophageal cancer recurrence after curative esophagectomy?

Thoracic Cancer ◽

10.1111/1759-7714.12996 ◽

2019 ◽

Vol 10 (4) ◽

pp. 769-774 ◽

Cited By ~ 1

Author(s):

Yusuke Taniyama ◽

Tadashi Sakurai ◽

Makoto Hikage ◽

Hiroshi Okamoto ◽

Chiaki Sato ◽

...

Keyword(s):

Esophageal Cancer ◽

Cancer Recurrence ◽

Curative Esophagectomy

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Room for improvement? The adoption of multimodal esophageal cancer care in the United States.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.4_suppl.78 ◽

2011 ◽

Vol 29 (4_suppl) ◽

pp. 78-78

Author(s):

R. P. Merkow ◽

K. Y. Bilimoria ◽

M. McCarter ◽

A. Stewart ◽

W. B. Chow ◽

...

Keyword(s):

Esophageal Cancer ◽

Neoadjuvant Therapy ◽

Surgical Resection ◽

Tumor Size ◽

Locally Advanced ◽

The United States ◽

Stage I ◽

Stage Ii ◽

Cancer Data ◽

Factors Associated

78 Background: Consensus guidelines recommend neoadjuvant chemo- or chemoradiation therapy as the preferred treatment for locally advanced esophageal adenocarcinoma; however, it is unknown if this recommendation has been widely adopted in the U.S. Our objective was to examine esophageal cancer multimodal therapy and identify factors associated with the use of neoadjuvant therapy. Methods: From the National Cancer Data Base, patients with middle third, lower third and GE junction (GEJ) adenocarcinomas were identified. Patients who were clinical stage I-III and underwent surgical resection were included. Separate logistic regression models were developed to identify predictors of neoadjuvant therapy utilization and outcomes. Results: From 1998 to 2007, 8,051 patients underwent surgical resection for esophageal cancer: 16.3% stage I, 45.0% stage II and 38.7% stage III. For stage II/III tumors, neoadjuvant use increased (49.0% to 77.8%, p<0.001). After adjustment, factors associated with underuse of neoadjuvant therapy in stage II/III patients were older age, Black or Hispanic ethnicity, more severe comorbidities, tumor location (GEJ and middle vs. lower third), tumor size ≥ 2cm, stage II (vs. III) and geographic region. Stage II/III patients not receiving neoadjuvant had an over two fold increased risk of positive lymph nodes (OR 2.14. 95% CI 1.79 – 2.55, p<0.001). In addition, the positive surgical margin rate increased almost three fold (OR 2.80 95% CI 2.17-3.62, p<0.001) but 30-day postoperative mortality risk was not significantly affected (OR 1.50 95% CI 0.94-2.39; p=0.090). For stage I patients, neoadjuvant therapy decreased over time (38.0% to 11.4%, p<0.001). The overuse of neoadjuvant therapy was associated with higher tumor grade, larger tumor size, and low surgical case volume (all p<0.05). Conclusions: The adoption of neoadjuvant therapy has increased in the past decade; however, opportunity exists to improve guideline treatment for locally advanced esophageal cancer. Registry-based feedback to individual hospitals, such as benchmark comparison tools, could help institutions provide care in concordance with national guidelines. No significant financial relationships to disclose.

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Survival in patients with esophageal cancer treated with surgery after chemoradiotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.4_suppl.98 ◽

2013 ◽

Vol 31 (4_suppl) ◽

pp. 98-98

Author(s):

Ravi Shridhar ◽

Jessica Freilich ◽

Sarah Hoffe ◽

William J. Fulp ◽

Michael Chuong ◽

...

Keyword(s):

Esophageal Cancer ◽

Radiation Dose ◽

Surgical Resection ◽

Randomized Trials ◽

Tumor Location ◽

Tumor Length ◽

Lower Stage ◽

Radiation Technique ◽

Nonsurgical Patients

98 Background: Chemoradiotherapy (CRT) followed by surgical resection is the standard of care for treating advanced esophageal cancer. However, the role of surgery has come into question in recent studies. The purpose of this study is to compare outcomes of patients treated with CRT with or without surgery. Methods: An IRB-approved database was queried to identify esophageal cancer patients treated with CRT with or without surgical resection between 2000 and 2011. Overall survival (OS) and disease-free survival (DFS) were calculated by the Kaplan-Meier method and log-rank analysis. Multivariate analysis for OS and DFS were calculated with a Cox proportional hazard ratio model. Results: We identified 232 patients treated with CRT (122 without surgery, 110 with surgery). Surgery was associated with a significant increase in OS and DFS. Median and 5 year OS for surgical versus nonsurgical patients was 42.2 months, and 42.3% versus 20.4 months and 29%, respectively (p = 0.0003). Median and 5 year DFS for surgical versus nonsurgical patients was 16.8 months and 29% versus 8.4 months and 22.8% (p < 0.001). MVA for OS revealed that lower stage (p = 0.0098), tumor length <5 cm (p = 0.0059), and surgery (p<0.0001) were prognostic for significantly decreased mortality, while age, gender, histology, tumor location, radiation dose, and radiation technique were not prognostic. MVA for DFS showed that tumor length <5 cm (p = 0.0112), radiation technique (p = 0.0023), and surgery (p = 0.0007) were prognostic for significantly decrease mortality, while lower stage (p = 0.069) and squamous histology (p = 0.055) were trending for decreased mortality. Age, gender, radiation dose, and tumor location were not prognostic for DFS. Conclusions: Surgery after CRT is strongly associated with increased OS and DFS in our esophageal cancer patient population. While we highly recommend surgical resection as part of trimodality treatment, it should only be performed in high volume centers. Longer followup in the already conducted randomized trials involving squamous cell carcinomas are needed to better qualify the initial negative results and randomized trials are need to address the role of surgery for adenocarcinomas.

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